Connecticut Seal

General Assembly

 

Raised Bill No. 6471

January Session, 2011

 

LCO No. 3264

 

*03264_______INS*

Referred to Committee on Insurance and Real Estate

 

Introduced by:

 

(INS)

 

AN ACT PROHIBITING MOST FAVORED NATION CLAUSES IN HEALTH CARE PROVIDER CONTRACTS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subdivision (2) of subsection (a) of section 38a-479 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011):

(2) "Provider" means a physician, surgeon, chiropractor, podiatrist, psychologist, optometrist, natureopath, [or] advanced practice registered nurse or dentist licensed in this state or a group or organization of such individuals, who has entered into or renews a participating provider contract with a contracting health organization to render services to such organization's enrollees and [enrollee's] enrollees' dependents.

Sec. 2. Section 38a-479b of the general statutes is amended by adding subsection (c) as follows (Effective October 1, 2011):

(NEW) (c) No contracting health organization shall include in any participating provider contract, contract with a hospital licensed under chapter 368v or contract offered to a provider or hospital any clause, covenant or agreement that:

(1) Requires the provider or hospital to:

(A) Disclose to the contracting health organization the provider's or hospital's payment or reimbursement rates from any other contracting health organization the provider or hospital has contracted, or may contract, with;

(B) Provide services or procedures to the contracting health organization at a payment or reimbursement rate equal to or lower than the lowest of such rates the provider or hospital has contracted, or may contract, with any other contracting health organization;

(C) Certify to the contracting health organization that the provider or hospital has not contracted with any other contracting health organization to provide services or procedures at a payment or reimbursement rate lower than the rates contracted for with the contracting health organization;

(2) Prohibits or limits the provider or hospital from contracting with any other contracting health organization to provide services or procedures at a payment or reimbursement rate lower than the rates contracted for with the contracting health organization; or

(3) Allows the contracting health organization to terminate or renegotiate a contract with the provider or hospital prior to renewal if the provider or hospital contracts with any other contracting health organization to provide services or procedures at a lower payment or reimbursement rate than the rates contracted for with the contracting health organization.

This act shall take effect as follows and shall amend the following sections:

Section 1

October 1, 2011

38a-479(a)(2)

Sec. 2

October 1, 2011

38a-479b

Statement of Purpose:

To prohibit managed care organizations and preferred provider networks from including most favored nation clauses in contracts with health care providers and hospitals.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]